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Introduction: The phimosis condition is characterized by the inability to retract the foreskin on the glans, making it impossible to expose them. Surgical treatment, although effective, has been questioned by the risk to which the patient is exposed. Therefore, we have opted for the use of topical corticosteroids to resolve this pathology. Goals: To compare the effectiveness of Dexamethasone and Hyaluronidase + Betamethasone Valerate associated with preputial massage in the treatment of infantile phimosis, the degree of regression of phimosis, the time needed to achieve complete efficacy, possible adverse reactions, long-term outcome and parental adherence to treatment in children attending a specialized service in Blumenau, Santa Catarina. Materials and methods: Controlled clinical trial, quantitative, non-blind, prospective and randomized sample analysis through the analysis of 523 patients. Results: After 1 month of treatment, 435 patients presented some degree of regression and 63 children were referred to surgery. The success rate in this period was 45.8% in boys who were taking Hyaluronidase + Betamethasone Valerate and 49.8% in those who used Dexamethasone. In the late evaluation, 398 children reached grade 0, and 213 used Hyaluronidase + Betamethasone Valerate and 185, Dexamethasone; 39 patients were referred to the postectomy. Adherence to treatment was similar in both groups. The average time for degree 0 to be reached similar in both. Conclusion: Both topical corticosteroids were effective in the resolution of phimosis. However, in the evaluation after the first month and in the regression, Dexamethasone proved to be more effective. The time to resolution of the condition was similar for both. The surgical procedure was taken when there was no clinical improvement. No adverse effects were reported in both groups.

Behavioral dentistry is an interdisciplinary science, which needs to be learned, practiced and reinforced in the context of clinical care and within the community oral health care system. The objective of this science is to develop in a dental practitioner an understanding of the interpersonal, intrapersonal, social forces that influence the patients’ behavior. The clinician must acquire knowledge to develop appropriate behavioral skills with an improved quality of communication and management of patients. Behavior dentistry also teaches to develop a recognition and understanding that the body and mind are not separate entities and focuses on patients’ social, emotional and physiological dental experiences. Behavior is an observable act. It is defined as any change observed in the functioning of an organism. Learning as related to behavior is a process in which experience or practice results in relatively permanent changes in an individual’s behavior. Self-perceptions of dental-facial appearance begin with aesthetic values shared within families and based generally on social norms, but that they may be strongly influenced by peer values and specific experiences of individual children, particularly those involving social responses. Theories incorporating concepts of social comparison and self-efficacy suggest that individuals evaluate themselves in comparison with others in their social environment. Children who perceive themselves to be attractive will reflect those perceptions in their behaviors and generally will receive confirming social responses. The comparison group may express an attractiveness norm that reflects negatively on the individual’s behavior. This, in turn, can affect the individual perceived sense of self-efficacy or adequacy within that group and lead to behaviors that reflect more negative beliefs about the self, thereby inviting still more negative social responses. Patient cooperation is the single most important factor every dentist must contend with. Major considerations are • Regularity in keeping appointments • Compliance in wearing removable appliances • Refraining from chewing hard and tenacious substances that are likely to distort or damage the teeth or crowns • Maintenance of oral hygiene. Laxity in following these instructions may lead not only to compromised treatment but also to slow progress of treatment, loss of chair time and frustration. What may be more interesting to the Dentist than the shaping of self-perceptions in the shaping of behavior that will ensure a successful result of treatment, that is, the patient’s adherence to prescribed routines for self-care and other regimens during Dental treatment. It is helpful in this regard to know that most patients expect improved dental-facial appearance as an outcome of treatment, but there is much more to know about factors influencing cooperation. Poor motivation can also contribute to non-compliance. The regulatory loop requires a motivational system to adjust behavior to coincide with the recommended regimen. A patient may recognize that the regimen is not being followed and yet simply not be motivated to correct the discrepancy. Poor motivation can also result from a lack of concern over the long-term health consequences of one’s behavior and/or a lack of belief in the treatment. Cognitive approaches that emphasize the personal relevance of the regimen or address misconceptions about the treatment may enhance motivation. Several approaches may be useful in treating poor compliance. Providing incentives or rewards for compliant behavior might be a useful strategy to enhance motivation. The cause of noncompliance is multifactorial and strategies to improve compliance must be tailored to fit each situation. Current Dental research focuses on a critical aspect of the feedback; specifically, the input received by the comparator that quantifies the actual amount of adherent behavior. Likewise, Patients, parents, and clinicians need a way to ascertain this information.

Alterations in cardiac autonomic modulation of children and obese preadolescents have attracted the attention of researchers around the world. These alterations cause disorders in the cardiac autonomic control and can interfere in cardiac output and in the homeostatic actions that depends on the cardiovascular system action.

Calcium is the most common element in the tooth’s structure. In addition, calcium is one of the elements that are effective in maintaining dental health. As a result of calcium deficiency, the tooth becomes brittle and begins to rot. Calcium deficiency usually occurs in acidic beverage consumption and during canal treatment. A study was conducted to determine the degree of calcium removal in the root canal dentin after 17% EDTA, 17% EGTA, 15% EDTAC and 1% tetracycline-HCl treatment; later with or without 2.5% NaOCl [1]. Extracted single-rooted human teeth were bisected longitudinally and the root halves (n = 100) were isolated with nail varnish, leaving the root canal exposed. The samples were immersed in the test solutions for 1 and 5 minutes, after which the amount of calcium ion (Ca2+) release into the solutions was determined by flame photometry. The calcium ions (Ca2+) present in hydroxyapatite crystals are one of the main inorganic elements of dentin [2]. It has been reported that some chemicals used for endodontic irrigation are capable of causing alterations in the chemical composition of dentin [3-6]. MethodsDetermination of calcium in the tooth’s structure is very important. Calcium determination, Flame Emission Spectrofometry and inductively coupled plasma optical emission spectrometry (ICP-OES) methods can be performed. These methods can be analyzed in a short time without interference effects. In both methods, the calcium in the tooth is stimulated and the emission intensity it emits is measured as it becomes basic. These emission intensities are directly proportional to the calcium concentration. Also, in these methods, calibration graph or standard addition method is used for calcium determination. The roots were then bisected longitudinally, and the pulp tissue was removed with a toothbrush. All root halves (n = 100) were dehydrated in a sterilizer at 120 °C until they reached a fixed weight, as verified by consistent readings using a precision scale (Sartorius, Gotingen, Germany; precision = 0.0001 g). Thereafter, the specimens were covered with two consecutive layers of nail varnish, leaving the root canal surface exposed. The samples were randomly distributed into the following treatment. Groups: Group 1: 2.5% NaOCl Group 2: 17% EDTA Group 3: 17% EGTA Group 4: 15% EDTAC Group 5: 1% Tetracycline-HCl Group 6: 17% EDTA _ 2.5% NaOCl Group 7: 17% EGTA _ 2.5% NaOCl Group 8: 15% EDTAC _ 2.5% NaOCl Group 9: 1% Tetracycline-HCl _ 2.5% NaOCl Group 10: Distilled water (negative control) In each group, the specimens were immersed in a magnetic stirrer bath containing 10 ml of test solution for 1 and 5 minutes. In groups 1 and 10, the same samples (n = 10) were used for 1- and 5-minute treatments. Calcium is measured between 10 and 1000 ppm (mg/L) with Flame emission intensity. Calcium at a lower concentration cannot be measured. Inductively coupled plasma optical emission spectrometry (ICP-OES) is a widely used method recently. ICP-OES is an advanced high-end method of flame emission spectrophotometer. In this method, the energy source required for excitation is provided by plasma and its temperature is between 4000 and 10000 ⁰C. There is a certain wavelength of light to which each element is stimulated. The wavelength of the light used for calcium is 455,531 nm. At this wavelength, a calibration graph is prepared from standard solutions of calcium. Calcium in the tooth is measured using the calibration chart. The sensitivity of this method is high. Calcium analysis in ppm (mg/L) and ppb (µg/L) concentration can be analyzed with ICP-OES. In this method, the analysis takes minutes. Therefore, it is used in routine analysis. ConclusionUsing these methods, you can easily analyze the calcium found in the structure of the tooth. Also, disinfectant like hypochlorite used during canal treatment increases the calcium release of the tooth. Therefore, the released calcium can also be analyzed using these methods. Here, each sample takes at least 5 measurements and gives the results in accordance with the scientific representation.

Non-invasive electrical stimulation in the form of neuromuscular electrical stimulation (NMES) and functional electrical stimulation (FES) has been documented as an optional assessment and treatment technology for decades. In contrast, translation of the robust clinical evidence supporting the effectiveness of FES’ enhancement of muscle force generation and adding to the recovery of motor control following damage to the brain appears limited. Furthermore, enabling many patients to regain locomotion ability though utilization of FES as a standard care option in rehabilitation medicine remains unmet. This perspective evolved over years of collaborative experience in clinical research, teaching, and patient care having a common goal of advancing patients’ rehabilitation outcomes. The clinical successes are supported by repeated evidence of FES utilization across the life span, from toddlers to elders, from hospitals’ critical care units to the home environment. The utilization include managing multiple deficits associated with the musculo-skeletal, neurological, cardio-pulmonary, or peripheral vascular systems. These successes were achieved in no small part because of the technological advancement leading to today’s wearable wireless FES systems that are being used throughout the continuum of rehabilitation care. However, failures to benefit from FES utilization are likewise numerous, collectively depriving most patients from using the technology to maximize their rehabilitation gains. The most critical failures are both clinical and technological. Whereas numerous barriers to NMES and FES utilization have been published, the focus of this perspective is on barriers not considered to date.

Cement-retained implant-supported restorations has been preferred by many clinicians due to its ease of production, low cost and similarity to dental supported restorations [1]. In the literature, many complications caused by residual cement, ranging from acute severe bone resorption to implant loss, have been published as a case report/ series [2-7]. In another study [8], residual cement was seen in 81% of implant cases that are clinically identified as peri- implantitis. Hence it has been indicated that a strong relationship has been determined between residual cement and development of chronic peri-implant infection [9].

Depressive disorders are so frequent and disabling health conditions which have been inarguably accepted to be a public health concern [1]. Many drugs have been developed to treat depression, however the efficacy of the antidepressants are inadequate particularly for mild or moderate depression [2-4]. It is also mentioned that when considering the trials about the treatment effect of the antidepressants, you should be careful about the results because of reflecting a small proportion of the society [4]. Despite the methodological issues related to the controversial results about the antidepressant efficacy, a recent review showed that the antidepressant effects of the drugs persist in a six month period [5,6].

The etiology of abdominal obesity is multifactorial and has environmental factors as its most expressive risk factors. This study cross-sectional analyzed the association of abdominal fatness with physical inactivity and food inadequacy of 1,557 subjects, both genders, over 35yrs. old, enrolled in an ongoing epidemiological study. Waist circumference (WC) was the primary variable and demographic, social-economic, anthropometric and dietary intake data, were the co-variables. NCEP-ATP III, WHO, IPAQ-long (version 8) and Healthy Eating Index were used for functional definition of variables. Furthermore, longitudinal data from 50 subjects in an exercise protocol for 10 week receiving either regular diet (G1, n=22) or 30g fiber adequacy (G2; =28), were analyzed. The performed statistical analyses used software SAS for Windows, version 9.1 with p=0.05. In a predominantly female sample (74%), 76% aging 35-60yrs, 64% completed elementary school, 73% were living in a low income household, 77.5% overweight. The 62.5% presenting altered WC values were predominantly older, presented higher body fatness, and were consuming low variety-poor quality diet rich in fat (mainly saturated) and lower in fruit. WC correlated negatively with fruit intake and aerobic capacity (VO2max) but only carbohydrate (positive) and fruit intake (negative) were considered independent risk factors for abdominal obesity. In the longitudinal study, both G1 and G2 groups were similar at baseline and G1 maintained the anthropometry values throughout the experiment. Conversely, G2 decreased total body (4%) and WC (7%) fatness, reducing severe obesity by 16%, minimally affecting overweight and eutrophic rates. G2 presented 211% increase in fiber intake and 150% increase in plasma beta-carotene (colorful-fiber marker). Thus, in conclusion, recommended dietary fiber intake (increased fruit and low CHO intake) and physical activity would be the recommended changes against abdominal obesity and, by associating both physical exercises and dietary fiber there was indeed a decrease in abdominal fatness and obesity, predominantly at its higher grade.

Internal jugular vein catheters (IJC) is recommended as the central venous access of choice in haemodialysis patients. However it is associated with complications of variable severity. Objectives: To study the complications associated with internal jugular vein catheters in haemodialysis patients in southern part of Nigeria. Methodology: The clinical details of patients who had IJC insertion at the kidney house, Hilton clinics Port Harcourt from 1st October 2011 to 30th September 2016 were documented. Complications from the IJC developed by the patients during the study period were also documented. The data obtained was analyzed using SPSS version 22. P value less than 0.05 was considered significant. Results: A total of 129 patients had 150 internal jugular catheter insertions. The mean age was 51.4±15.2 years with male to female ratio of 1.5:1. All the patients had chronic kidney disease; about 80% had tunneled IJC and 96.9% of the catheters were inserted in the right internal jugular vein. Immediate complications were recorded in 10% and late complications in 34.9% of the procedures. The immediate complications were kinking of guide wire (2%), arterial puncture (1.3%) and difficulty in locating the internal jugular vein (1.3%) or tunneling (1.3%). The late complications were infection (12.8%), poor blood flow (9.2%), bleeding (5.5%) and spontaneous removal of the catheter (5.5%). There was no statistical significant difference in both immediate and late complication with age and sex. The ultrasound examination at discharge had a sensitivity of 31% and specificity of 87% to detect future symptomatic lymphoceles. The positive predictive value was only 10%. The second ultrasound test had the best test variables to detect symptomatic lymphoceles with a sensitivity of 93% and a specificity of 87% and a predictive value of 28%. Conclusion: Internal jugular catheter is froth with immediate and late complications in haemodialysis patients.

Introduction: With the availability of different post systems and various studies on the strength of teeth restored with posts, the controversy as to which post systems provide better stress distribution of post and longevity of tooth has not been resolved. The purpose of this study was to compare the stress distribution of three different post materials using finite element analysis. Materials and nethod: Three dimensional finite element models of central incisor, three posts with crown were constructed on computer with software. Posts of three different materials (Ni-Cr post, Glass fiber post, and Zirconia post)with zirconia crown were virtually generated and a force of 100 N was applied at an angle of 450 on the palatal surface of the crown. Von Mises stresses were evaluated on the cervical, middle and apical third of the root. Results: The maximum stresses were seen on the cervical one-third in each post material indicating that this region is more prone to fracture in tooth restored with posts. Among the three materials tested, Ni-Cr post showed maximum stress generation followed by Zirconia post and glass fiber post. The maximum stresses generated by the posts were 11.4 MPa, 10.58 MPa and 4.11 MPa respectively. Conclusion: The less rigid post material like glass fiber post can be used in an endodontically treated anterior teeth.

Background: Hyperuricosuria, persistently low urinary pH, and low urinary volume are the main risk factors of uric acid nephrolithiasis. Epidemiologic studies suggest that high water intake is protective against the occurrence of symptomatic kidney stone events of all types. The objective of this systematic review and meta-analysis were to evaluate the effectiveness of increased water intake to prevent symptomatic uric acid kidney stone events. Methods: Seventeen studies were identified for the meta-analysis. Analysis of Q and I2% statistics revealed that a high heterogeneity in 16 studies, thus, random effects model was used. Protective associations were identified for high water intake individuals (SMD=0.52 L; 95% CI: 0.19, 0.84; p=0.002); a significantly decreased relative super saturation of uric acid versus controls (SMD=-1.15; 95% CI: -2.00, -0.30; p=0.008). Risk factors including urinary uric acid excretion and pH were not significantly related to high water intake (SMD=7.32mg/d, 95% CI: -52.27, 66.91; p=0.81), (SMD=0.14; 95% CI: -0.02, 0.31; p=0.09), respectively. Further subgroup analyses revealed that urinary uric acid excretion was significantly decreased in healthy individuals (SMD=-36.23 mg/d, 95% CI: -65.14, -7.31; p=0.001) compared to stone formers (SMD=27.41 mg/d, 95% CI: -33.18, 88.01; p=0.38); urinary uric acid excretion was significantly decreased in routine water intake groups (SMD=-61.49 mg/d, 95% CI: -120.74, 12.24; p=0.04) compared to mineral water intake groups (SMD=44.50 mg/d, 95% CI: -18.30, 107.29; p=0.16); urinary pH was significantly higher in mineral water groups (SMD=0.13, 95% CI: 0.01, 0.46; p=0.04) compared to regular water groups (SMD=-0.00, 95% CI: -0.13, 0.13; p=0.98). Results: A total of 129 patients had 150 internal jugular catheter insertions. The mean age was 51.4±15.2 years with male to female ratio of 1.5:1. All the patients had chronic kidney disease; about 80% had tunneled IJC and 96.9% of the catheters were inserted in the right internal jugular vein. Immediate complications were recorded in 10% and late complications in 34.9% of the procedures. The immediate complications were kinking of guide wire (2%), arterial puncture (1.3%) and difficulty in locating the internal jugular vein (1.3%) or tunneling (1.3%). The late complications were infection (12.8%), poor blood flow (9.2%), bleeding (5.5%) and spontaneous removal of the catheter (5.5%). There was no statistical significant difference in both immediate and late complication with age and sex. Conclusion: This meta-analysis identified evidence that urinary uric acid excretion, volume, pH and relative supersaturation of uric acid can be altered with high water intake intervention, reducing the risk of uric acid kidney stones.

Introduction: Number of obese people is growing on a daily basis in Brazil, including morbid obese ones, but there is still a lack of studies with this subject. Due to this, the main goal of this study was to identify body profile, physiological variables behavior and oxygen consumption in grade III obese women, submitted to an ergospirometric test in arm ergometer. Method: Take part in this study, thirteen (13) female grade III obese patients between 20 and 40 years. They were submitted to an electric bioimpedance test for body composition measurement and an Ergospirometric test in arm ergometer for oxygen consumption, heart rate, and oxygen saturation, systolic and diastolic arterial pressure, resting and after exercises, analysis. Results: The patients revealed a BMI of 46.5±3.81 kg/m², 51.9±1.59% of body fat percentage. The patients reached 168.2±4.57bpm of heart rate, didn’t make any hypertensive response to the effort reaching an arterial pressure of 171.1±22.15mmHg x 87.5±4.18mmHg. Oxygen saturation was 98±0.71% and oxygen consumption peak was, also in average, 12.3±2.75ml.kg.min-1. Conclusion: It was verified that there was no oxygen saturation drop nor hypertensive response and all of the patients reached the maximum heart rate. 

Introduction: Obesity may cause progressive chronic kidney disease. Weight loss in the postoperative follow-up of bariatric surgery may improve renal function in these patients. Thus, the purpose of this study was to give insight on the subject using a sensible biomarker. Methods: This cross sectional study was performed in the Obesity Department from Campina Grande – Paraiba, Brazil. It was randomly enrolled 23 postoperative patients (7 bypass and 16 sleeve), with at least two years of follow-up, from the outpatient Department and 29 (18 bypass and 11 sleeve) in the preoperative period for bariatric surgery. They were homogeneously from both genders with ages ranging from 25 to 57 years. Serum levels of creatinine and cystatin C were measured, and the glomerular filtration rate (GFR) was estimated using the CKD Epi (chronic kidney disease epidemiology collaboration) cystatin-creatinine equation. The investigation was approved by the Ethics Committee. Results: The mean body mass index (BMI) of the preoperative group was significantly greater than the postoperative group (p ≤ 0.0001). The mean serum levels of C cystatin was significantly greater in the postoperative group as compared to preoperative (p= 0.0197). However, there was no mean difference between creatinine serum concentrations comparing the two groups (p = 0.3252). The mean glomerular renal function rates of the groups were similar (p = 0.1240). Conclusion: There is no definitive evidence for supporting the hypothesis that there is improvement in the kidney renal function after bariatric surgery in obese patients. Prospective cohorts are necessary to enlighten the answer for this important question.

The patient with an oncological disease presents a series of discomforts related to the psychological sphere such as depression, pain, sense of usefulness, anger, but also inconveniences related to food sphere. Neoplastic disease interferes with eating behaviour for several reasons. The communication of the diagnosis can create a state of anorexia as a result of the shock; certain tumours of the gastrointestinal tract-gold (mouth, esophagus, stomach, colon and rectum, but also pancreas and liver) are directly responsible for the possible alteration of food intake; alteration in eating behaviour may be secondary to the main therapeutic treatments. The link between food and cancer is not only evident in case of disease, but also in case of prevention, in fact a growing number of studies indicates more an more clearly the close correlation between a healthy diet and prevention of oncological diseases although at present time it is not still possible to give definitive results. The diagnosis of a person is like a melody in which some notes are repeated but their combination is almost infinite, because each person has different eating needs, as well as different psychological needs, and the starting point for a good professional must necessarily be a ‘customized’ diagnosis. This ‘diagnosis of well-being’, tailor-made for each person, involves professionals in both the food and psychological and behavioural sectors, since the individual needs have to be evaluated globally. Finally, the professionals of human behaviour in food consumption, and the chemical and science processing experts, have the duty not to limit themselves to a single refusal against the use of certain foods, but framing the phenomenon in a wider perspective and, as experts of human health, to propose alternatives.

Heftiness, a mind boggling interchange among ecological and hereditary factors and is related with critical horribleness and mortality. Utilization of herbs for the administration of heftiness in the ongoing occasions is pulling in consideration. A web and manual based writing overview was led to survey the measure of data accessible on the natural items for weight administration. Customary writing, PubMed, Scopus, Google researcher databases were screened up to February 2012. The pursuit words were “stoutness”, “home grown medication/items/separates”, “restorative plants”, “customary drug”, “Ayurvedic prescription” without narrowing/constraining looking words or components. Distributions just with edited compositions/full articles and books were inspected in the pursuit. In light of the accessible writing, for huge numbers of the natural and weight reduction items, there is minimal distributed data and there have been no clinical preliminaries or the level of proof is restricted. Our writing study additionally demonstrated that these home grown items fall under an adequate level of proof or with no scientific foundation by any stretch of the imagination, or they have a logical discerning however not to an acknowledgment level. Endeavors were made in the audit to characterize the highlights of conceivable natural weight reduction item. A perfect home grown enemy of stoutness item ought to diminish the weight by 10% over fake treatment of treatment by demonstrating a proof of change of bio markers like blood pres-beyond any doubt, lipids and glycemia with no reactions.

Background: A structured multidisciplinary team is very important during every phase of the amputation process and a good communicative team guarantees a greater tranquility for the patient, thanks to more homogenous information, that is already discussed between the clinicians. Aim: The aim of this study was to define the efficacy and outcome value of an innovative procedure tool (TRIA-MF protocol) in the treatment of lower limb amputees before and after prosthesis use with the purpose to quantify the quality of the procedure and its economic impact on the clinical patients’ recovery. Setting: A rehabilitation institute for the treatment of neurological and orthopaedic gait disorders. Methods: 12 patients (4 women and 8 males) subjected to lower limb amputation and admitted according to the principles of inclusion criteria of the TRIA-MF protocol at the Rehabilitation Department of the Clinical Institute Città di Brescia were recruited in this study. All patients were included in an integrated and task-specific management protocol of the amputee, which allowed to follow the rehabilitation process from amputation to the final restoration, for a period of 6 months for each patient. Patients were evaluated 5 times during the study, collecting their degree of pain (VAS), their independence profile (Barthel Index) and the cirtometry of their amputation stump. Data on the duration of their admission to the rehabilitation unit, the inter-time between the amputation and acquisition of the temporary prosthesis, and between temporary prosthesis acquisition and the final prosthesis acquisition were also reported. Results: Patients of our sample, at the end of their hospitalization, highlight a significant modification of the temporal data at 1 month and 6 months from their hospital discharge. A statistical significant increase of the Barthel Index value was observed in all patients recruited in this study proceeding from time T0 to time T4; in the same way, a statistical significant decrease of the VAS scale was observed in all patients recruited proceeding from time T0 to time T4; the cirtometry of the amputation stump (expressed in cm) showed a statistical significant decrease in all patients recruited proceeding from time T0 to time T4. We haven’t observed a statistical significant correlation between the duration of the rehabilitative hospitalization and our clinical data; no statistical significant correlation was observed between the amputation stump cirtometry time-related modification and our intertime data. Conclusions: The protocol was found to be a clear and relevant tool with the definition of the operational profile for each single professional figure involved; it could also be considered as an optimal tool for coding the management and evaluation of the effectiveness of amputee treatment, with a related high reproducibility, sensitivity and specificity profile. In line with the literature, the TRIA-MF protocol has allowed us not to exceed a period of hospitalization in rehabilitation units of more than 23 days, thus showing that it is an excellent tool for optimizing the management costs of the amputee over time.

Chronic kidney disease (CKD) is a highly prevalent disease, imposing high mortality rates worldwide, and it is closely related to cardiovascular events. Vitamin D deficiency is very prevalent in patients with CKD from the earliest stages of the disease, and it has been associated with higher mortality. In order to assess the prognostic implications of vitamin D deficiency in CKD, we undertook a literature review, searching different databases in October 2018 for publications related to vitamin D in patients with CKD and hypovitaminosis D, and not on dialysis. The main cause of death in these patients is cardiovascular disease. Vitamin D is one of the first parameters that CKD changes and has an important prognostic role in this entity. Deficient levels in blood are associated with increased cardiovascular risk and survival impacts, independently of cardiovascular disease. Treatment with paricalcitol appears to reduce this risk. However, the evidence analyzed is insufficient to establish an association between vitamin D levels and the progression of kidney disease. 

Introduction: In endodontically treated teeth, dentinal defects such as microcracks can progress to a vertical root fracture and lead to tooth loss. Objective: The present study aimed to evaluate, by micro-computed tomography analysis, the formation of dentinal microcracks during filling removal in endodontic retreatment of root canals filled with gutta-percha and Total Fill BC bioceramic sealer. Methods: Twenty mesial roots of mandibular molars were instrumented and obturated with gutta-percha and Total Fill BC sealer and then the filling material was removed with rotary Protaper Retreatment files. The specimens were scanned before instrumentation, after filling and after retreatment. The transversal images obtained after filling were compared with the images obtained after removal of the filling material. A descriptive statistical analysis was performed. Results: Among the 24.444 cross-sections analyzed, 5.67% presented some type of dentinal defect, with 0.51% in the initial images, 2.58% in the post-filling images and 2.58% in the post-retreatment images. All the dentinal defects identified in the images obtained after the retreatment were already present in the corresponding images after the filling. New dentinal microcracks were not observed after removal of the filling material. Conclusion: Retreatment of mesial roots of mandibular molars filled with a silicate-based root canal filling material do not influence the formation of dentinal microcracks.

The childhood obesity is increased more than three folds in last two decades in developed world. There is nutritional transition seen in the developing world including India. The westernization in diet of the Indian population along with prosperity brings the brunt of overweight and obesity. This has future implications of liver diseases, heart diseases, hypertension, hyperlipidaemia, insulin resistance; malignancies. Mumbai is the prosperous city and an economical capital of India. Also, the rampant use junk food, common outdoor eating’s, no grounds to play for children make the high likelihood that the prevalence of obesity to be higher than rest of the country. It can profoundly affect children’s physical health, social, and emotional well-being and self-esteem. It is also associated with poor academic performance and a lower quality of life experienced by the child. One of the best strategies to reduce childhood obesity is to improve the eating and exercise habits of the entire family. Treating and preventing childhood obesity helps protect the child’s health and has tremendous impact on child’s Physical and academic performance. And hence we at Aastha Bariatrics took initiative and launched ECHO... for a change (‘E’radicating ‘C’Hild ‘H’ood ‘O’besity), a pan Mumbai campaign against childhood obesity. This campaign was done in 15 high schools across Mumbai, which covered in total of 9000 students.

Introduction: Pulmonary hypertension (PH) is prevalent in hemodialysis (HD). In the general population, more women than men have PH due to left ventricular (LV) disease with preserved ejection fraction (EF). Little is known about the gender-specific prevalence of PH and associated LV abnormalities in patients with end stage renal disease (ESRD) on HD. Our aim was to evaluate gender differences and LV structural and functional changes in PH among ESRD patients on HD. Methods: Ninety-four patients (ages 23-77 years) underwent echocardiography after HD. Patients were divided based on estimated pulmonary artery systolic pressure (PASP) (Group A PASP < 40 mm Hg, Group B PASP ≥ 40 mm Hg). LV measurements included LV mass, LV internal dimensions, and LV ejection fraction (EF). LV diastolic function (LVDF) was assessed from mitral inflow deceleration time (DT) and E/A ratio. Results: Fifty-five patients (59%) had PH, including 32 of 49 men (65%) and 23 of 45 women (51%). LVEF was lower in Group B (46.4 ± 17.6 vs. 62.4 ± 14.4%, p < 0.001). Men with PH had higher LVIDd, cm (5.52 ± 0.89 vs 4.78 ± 0.75, p < 0.001), LVIDs, cm (3.75 ± 0.94 vs 3.14 ± 0.91, p = 0.03) LV mass, g (236 ± 74vs 189 ± 56, p = 0.02) and lower LVEF (40.0 ± 16.7 vs 52.0 ± 15.6, p = 0.008) than women. Conclusion: Patients on HD have a high prevalence of PH. PH was not associated with clear LV structural changes. There was a depression in LV systolic function without changes in LVDF. PH patients were more often men with hypertrophied LV with depressed LV systolic function.